Survey Draft

Survey/Questionnaire

Questionnaire - Healthcare Survey

Are you between the ages of 18 and 25 years old?

A. Yes

B. No

Are you male or female?

A. Male

B. Female

3. Do you currently have any form of health insurance?

A. Yes

B. No

4. When was the last time you visited a doctor?

A. In the last 1 month

B. In the last 6 months

C. In the last year

D) Last 5 years

E) Last 10 years

F) I have Never been to a Doctor

5. Do you understand how to receive health care through the government?

A. Yes

B. No

6. Do you know any Ayurvedic Doctors?

A. Yes

B. No

7. Do you know any Medical Doctors – Doctors that practice United States style medicine?

A. Yes
B. No

8. Have you ever received health care from an Ayurvedic Doctor?

A. Yes

B. No

9. Have you ever received health care from a Medical Doctor who practices a United States style medicine?

A. Yes

B. No

10. When your parents or family go to the doctors what type of doctor do they usually visit?

A. Doctor of Ayurvedic Medicine

B. United States Style - Western

C. Mix of the Two

D. Other: Please Specify __________________

Situations:

Please answer the following 4 questions regarding several common medical conditions as if you were deciding what to do in each to the situations.

1.     After a long day of walking you trip just out side of your home and injure your leg. The injury is severe enough that bone is exiting the skin and you are in incredible pain. The nearest hospital isn’t for miles but you know several doctors in the area. What do you do?

A.   Look for a doctor in the area that practices Ayurvedic Medicine.

B.    Look for a doctor who practices a United States Style of Medicine.

C.    Find some one who is proficient in both Ayurvedic and Western Healthcare Practices.

D.   Other.

2.     You have a terrible headache that hasn’t gone away for a week. After talking with your family you decided to go find a doctor. What do you do?

A.   Look for a doctor in the area that practices Ayurvedic Medicine.

B.    Look for a doctor who practices a United States Style of Medicine.

C.    Find some one who is proficient in both Ayurvedic and Western Healthcare Practicies.

D.   Other.

3.     You are having a severe chest pains and your left arm is constantly throbbing from the shoulder down to your elbow. It has been a couple of hours and you are feeling faint. You decide to find a doctor. What do you do?

A.   Look for a doctor in the area that practices Ayurvedic Medicine.

B.    Look for a doctor who practices a United States Style of Medicine.

C.    Find some one who is proficient in both Ayurvedic and Western Healthcare Practices.

D.   Other.

4.     After the birth of a close friends child it is apparent that the baby is suffering from what appears to be some sort of mental handicap or retardation. After a couple of days the family asks your opinion as to what type of doctor they should visit. What type of doctor would you look for?

A.   Look for a doctor in the area that practices Ayurvedic Medicine.

B.    Look for a doctor who practices a United Stats Style of Medicine.

C.    Find some one who is proficient in both Ayurvedic and Western Healthcare Practices.

D.   Other.